Short research report
Estimating discharge dates using routinely collected data: improving the preparedness of parents of preterm infants for discharge home Peter J Fleming, Jennifer Ingram, Debbie Johnson, Peter S Blair Centre for Child and Adolescent Health, University of Bristol, Bristol, UK Correspondence to Professor Peter Fleming, Centre for Child and Adolescent Health, St Michaels Hospital, Southwell St, Bristol BS2 8EG, UK; peter.ﬂ[email protected]
uk Received 29 March 2016 Revised 31 August 2016 Accepted 14 September 2016 Published Online First 3 October 2016
ABSTRACT The length of stay for moderately preterm infants has progressively become shorter in the UK in recent years but staff still commonly inform parents that their baby will go home around their estimated date of delivery (EDD). Parents need as much notice as possible to prepare for the discharge of their baby, and to gain the necessary skills and knowledge to care for their infant safely. We report the use of routinely collected neonatal data to develop and implement a simple centile chart for date of discharge from hospital, which allows staff and parents to predict the likely discharge date more accurately for preterm infants, most of whom now go home more than 3 weeks before their EDD. This information allows better and timelier planning for discharge of such infants, by parents and staff.
To cite: Fleming PJ, Ingram J, Johnson D, et al. Arch Dis Child Fetal Neonatal Ed 2017;102: F170–F172. F170
Having a preterm baby places great strain on families, and preparing for the day when the baby comes home is a time-consuming and emotionally fraught activity. Parents, hospital and community staff need as much warning as possible of the likely date that a preterm infant will go home to ensure that all aspects of preparation are completed in good time, and not rushed at the last minute when a decision is made to discharge the baby. Historically, most paediatricians and neonatal nurses have told parents of preterm infants that the baby would probably go home around the time the baby would have been due to be born, the estimated date of delivery (EDD). Despite considerable evidence that, for many moderately preterm infants the length of hospital stay has been progressively shortening over recent years.1 2 In a survey of neonatal units in the UK in 2011, we found that most staff still used the EDD as the likely discharge date. Several recent studies have reported complex models using detailed information on infant condition and pathophysiology that allow estimation of likely length of stay (and thus date of discharge) for preterm infants.1–4 The main purpose of such models has been to allow generic comparison of standards and outcomes of care in different institutions and thus to raise overall standards rather than at the individual level. We report a simple approach to estimation of length of stay for preterm infants that is designed primarily to prepare staff and parents for the baby’s discharge rather than to compare practices in different institutions. This approach uses data routinely collected by the
What is already known on this topic? ▸ Most preterm infants are discharged to home well before their original estimated date of delivery (EDD). ▸ Neonatal staff still commonly inform parents that their infant is likely to go home around the time of the EDD. ▸ Preparation of parents for the discharge of their infant is commonly left until late in the course of the infant’s stay in hospital.
What this study adds? ▸ The clinical database routinely used in UK neonatal units allows the preparation of simple individualised centile charts for length of stay for infants in each neonatal network at each gestation. ▸ This allows staff and parents to know well in advance approximately when each infant is likely to be discharged.
‘Badger.net’ database used by almost all neonatal units in the UK.
METHODS Four local neonatal units (LNUs) in the Southwest region of England participated in a study that aimed to improve parental self-efﬁcacy for parents of preterm infants.5 This study required that we estimate as accurately as possible, early in the hospital stay, the likely date of discharge for participating infants. In this neonatal network, all infants born in an LNU at